Whelehans pharmacy migraine treatment

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This is a continuation of last two week’s articles in the Westmeath Examiner on migraines.

The key to successful treatment is to establish correct diagnosis of migraine and eliminate other potential causes (tension or cluster headache in particular). Some time spent with your pharmacist at an early stage to review current medication regime would also prove hugely beneficial in identifying and / or preventing “medicine overuse headache” (this is where the overuse of painkillers actually brings on headaches).

Analgesics

Used to target area specific pain and especially if taken as early as possible once an attack begins, analgesics can be a hugely effective pain killers.

Aspirin

Traditional first line of defence, has anti-inflammatory properties that can help alleviate many of the physical symptoms of migraine

Paracetamol

As effective as aspirin, but without the anti-inflammatory effects

Combinations

Drugs that contain aspirin or paracetamol along with another agent such as codeine or caffeine (eg.) Solpadeine^®

NSAID’s

Generally used for more severe migraine attacks, evidence shows Ibuprofen to be highly effective. Soluble forms may act quicker than tablet form for those where stomach issues are part of their migraine episode.

Triptans

Triptans are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70-80% of patients. Triptans target those neural serotonin receptors specifically involved in migraine attacks and can be used in the treatment of migraine with or without aura. All are available in tablet form with some brands also available as fast melt tabs, nasal spray or SC injection.

The most common triptans that are prescribed in Ireland are Sumatriptan (Imigran^®), Zolmitriptan (Zomig^®) and Frovatriptan (Frovex^®). Studies indicate that in over 60% of cases, triptans give significant pain relief within two hours. Approximately 30% of patients experience complete pain relief within two hours of taking a triptan.

In all cases, these are only for treatment where migraine has been diagnosed and not for the treatment of hemiplegic, basilar or ophthalmaplegic migraine.

Currently all triptans are prescription only in Ireland. Sumatriptan (Imigran^®) is now available over the counter in pharmacies in the UK without prescription; in the UK the patient requires a pharmacist consultation to see if it is suitable for them before they can purchase.

There is call from Irish pharmacists for sumatriptan to move to over the counter in Ireland and the HPRA (Health Product Regulatory Authority) are likely to authorise this change at some point